The DOI matches its Crossref record; 889 of the 893 references it cites were found in a registry or an index, and 4 are not checked yet.
2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association
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The individual reviewers' relationships with industry information is available in Appendix 2.This document was approved for publication by the governing bodies of the ASA and the AHA.It was reviewed for evidence-based integrity
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“Individuals with CKM stage 1 due to overweight and obesity are at increased risk for developing metabolic risk factors and CKD compared with those who have a normal weight without risk factors (CKM stage 0).5,6,41”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Even in the absence of these metabolic risk factors, excess weight is associated with increased cardiovascular risk, particularly for HF.6,42”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“There is a particular focus on preventing the development of excess and dysfunctional adipose tissue because the emergence of metabolic risk factors from youth and young adulthood into middle age is primarily related to weight gain with aging.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“For adults with overweight or obesity who have significant barriers to participating in multicomponent behavioral weight loss interventions, self-directed digital health solutions can be beneficial to promote weight loss for CKM syndrome risk reduction.5–7”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Among patients with CKM stage 1 to 3 and obesity without an adequate weight loss response to lifestyle modification, with or without the use of adjunctive obesity pharmacotherapies, MBS can be beneficial to facilitate weight loss and to mitigate CKM syndrome progression.1–8”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measured
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“MBS has efficacy among individuals with a BMI ≥35 kg/m2 regardless of the presence of comorbidities and can be beneficial in patients with T2D with a threshold BMI of 30 kg/m2.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Glycemia consistently improves with use of these agents, with some evidence for preventing progression to diabetes in those with insulin resistance.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“MBS has efficacy among individuals with a BMI ≥35 kg/m2 regardless of the presence of comorbidities and can be beneficial in patients with T2D with a threshold BMI of 30 kg/m2.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Counseling on dietary or combined dietary and exercise modifications effectively facilitates weight loss in postpartum women with GDM.6,19–21”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“RASi provide BP control and kidney and cardiovascular protection6 and are therefore preferred in patients with CKD and albuminuria.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Clinical trials and meta-analyses of SGLT2i in patients with CKD and T2D or CKD and UACR ≥200 mg/g without T2D have shown a significant reduction in risks of losing kidney function, kidney failure, cardiovascular death, and HF hospitalization when compared with placebo.5–7”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The presence of subclinical atherosclerosis (eg, elevated CAC) is associated with an increased cardiovascular risk among those with CKM risk factors (eg, diabetes, CKD).5–7”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A heart-healthy diet and regular physical activity remain the cornerstones of therapy in patients with T2D and ASCVD, with demonstrated benefits for CKM risk profiles.5–12”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In addition, habitual physical activity, including activities that reduce sedentary time, aerobic physical activity, and resistance training, are associated with improvements in several CKM risk factors (HbA1c, waist circumference, fat percentage, BP) and mortality.5–12”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“MBS is associated with a lower risk of incident major adverse liver outcomes and MACE in large cohort studies.6,24,25”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“and a 60% increased risk of stroke recurrence.35”
From Neurodegeneration and Stroke After Semaglutide and Tirzepatide in Patients With Diabetes and Obesity (2025) · cites this paper as [35]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Standard stroke care includes medical treatment, routine stroke therapy, and rehabilitative exercises, as outlined in the basic guidelines [35,36].”
From Smartphone-Based Speech Therapy for Poststroke Dysarthria: Pilot Randomized Controlled Trial Evaluating Efficacy and Feasibility (2024) · cites this paper as [36]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“In addition, current guidelines recommend short-term dual antiplatelet therapy after high-risk transient ischemic attack and minor stroke (198).”
From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [198]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“However, owing to the chronicity of obesity and multiple compensatory changes in metabolism, hunger, and satiety promoting weight recidivism,6 frequent and long-term engagement and behavioral support for lifestyle modification are needed for optimal effectiveness.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The cited source says what the claim attributes to it.
In the citing paper
“Additionally, as per clinical guidelines, persistently elevated triglycerides are considered a risk enhancer for ASCVD.2,4–6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“CAC assessment improves prediction of ASCVD4,5 and selection of patients for treatment with aggressive ASCVD risk factor modification (ie, statin therapy).6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“CorCal (Effectiveness of a Proactive Cardiovascular Primary Prevention Strategy, With or Without the Use of CAC Screening, in Preventing Future MACE)6 randomized 601 primary prevention patients to CAC (n=302) or risk calculator guidance (n=299) for primary prevention; the CAC arm had a greater reclassification of risk compared with the group using a risk calculator.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“At 1 year, statin adherence was superior, low-density lipoprotein cholesterol (LDL-C) levels were lower, and estimated costs were similar or reduced in the CAC arm.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“At 1 year, statin adherence was superior, low-density lipoprotein cholesterol (LDL-C) levels were lower, and estimated costs were similar or reduced in the CAC arm.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“At 1 year, statin adherence was superior, low-density lipoprotein cholesterol (LDL-C) levels were lower, and estimated costs were similar or reduced in the CAC arm.”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Once obesity is established, multiple compensatory mechanisms impacting metabolism, hunger, and satiety are triggered in the setting of intentional weight loss, which commonly result in weight regain.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In EMPA-Kidney, the risk reduction for the primary outcome (a composite of progression of kidney disease or death from cardiovascular causes) with empagliflozin compared with placebo was larger among patients with higher UACR (UACR ≥30–300: HR, 0.91; 95% CI, 0.65–1.26 versus UACR ≥300: HR, 0.67; 95% CI, 0.58–0.78).6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“However, the rate of eGFR decline after the initial decrease was slower in the empagliflozin group than in the placebo group in all key subgroups, including in the subgroup of patients with a UACR <30 mg/g.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Simulation studies suggest that combinations of CKM therapies may have additive benefits for heart and kidney protection.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“In the SELECT trial,6 17 604 participants with BMI ≥27 kg/m2 and established ASCVD (prior MI, stroke, or symptomatic PAD), and without T2D, end-stage kidney disease, or dialysis, were enrolled. The trial demonstrated a 20% reduction in risk of the composite primary endpoint of cardiovascular death, nonfatal MI, or nonfatal stroke for those treated with semaglutide (2.4 mg) as compared with placebo”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“A single-arm 15-week pragmatic weight management program (weekly consultations with exercise specialists, dietitians, and behavioral specialists), achieved a mean weight loss of 8.1 kg (−6.7%) for patients with obesity-related HFpEF.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Among patients with HFrEF, RASi improves both HF outcomes and risk for worsening kidney disease in several clinical trials.1–8,28”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“A directionally similar reduction in risk of the cardiovascular outcome (cardiovascular death, nonfatal MI, nonfatal stroke, or hospitalization for HF) was observed in a subgroup with CKD G4 in the FIDELITY meta-analysis of finerenone in diabetic patients, but this was nonsignificant and requires further investigation.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Metabolic and bariatric surgery causes remission of MASLD, even in advanced stages.6,24,25”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Hyperkalemia was more frequent in those with CKD G4 treated with finerenone.6”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“Abdominal adiposity is one of the strongest VTE risk factors.3,5–7”
From 2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome (2026) · cites this paper as [6]
Experimental — accuracy not yet measuredIn the citing paper
“Accordingly, many guidelines now recommend the addition of GLP-1RAs to ongoing antihyperglycemic regimens to lower the risk of stroke in type 2 diabetes.”
From Benefits of GLP-1 (Glucagon-Like Peptide 1) Receptor Agonists for Stroke Reduction in Type 2 Diabetes: A Call to Action for Neurologists (2022) · cites this paper as [7]
In the citing paper
“the American Heart Association/American Stroke Association guideline suggests GLP-1RAs as second-line to metformin regardless of baseline HbA1c in individuals with established atherosclerotic CVD to avoid further vascular events 7”
From Benefits of GLP-1 (Glucagon-Like Peptide 1) Receptor Agonists for Stroke Reduction in Type 2 Diabetes: A Call to Action for Neurologists (2022) · cites this paper as [7]
In the citing paper
“In the same vein, the 2020 Canadian Stroke Best Practices update for secondary prevention of stroke, 8 2021 Spanish Society of Neurology consensus statement, 9 2021 American Heart Association/American Stroke Association Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack, 7 and the Diabetes, Cardiorenal, and Metabolic Diseases Multispecialty Task Force 55”
From Benefits of GLP-1 (Glucagon-Like Peptide 1) Receptor Agonists for Stroke Reduction in Type 2 Diabetes: A Call to Action for Neurologists (2022) · cites this paper as [7]
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Metadata
- Authors
- Kleindorfer, D. O., Towfighi, A., Chaturvedi, S., Cockroft, K. M., Gutierrez, J., Lombardi-Hill, D., Kamel, H., Kernan, W. N., Kittner, S. J., Leira, E. C., Lennon, O., Meschia, J. F., Nguyen, T. N., Pollak, P. M., Santangeli, P., Sharrief, A. Z., Smith, S. C., Turan, T. N., & Williams, L. S.
- ORCID
- Venue
- Stroke
- Published
- 2021-07
- Volume
- 52
- Issue
- 7
- Pages
- e364-e467
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W3164908038
- Semantic Scholar
- 18bb9d19bdfe54d5d1289c0a74fbcb410e3e1b6d
- Cited by
- 3,237
- References
- 892
- Citations by year
- 2026: 653 · 2025: 670 · 2024: 778 · 2023: 618 · 2022: 432 · 2021: 82
- FWCI
- 72.98
- Type
- journal article
- Language
- en
- Update notices
- correction (2021-06-28)
- Open access
- bronze
- doi.org
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- Congress of Neurological Surgeons
- Topics
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cerebrovascular and Carotid Artery Diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- secondary stroke prevention, stroke recurrence, transient ischemic attack, stroke risk factors
- MeSH terms
- Clinical Decision-Making, American Heart Association, Ischemic Attack, Transient, Humans, United States, Practice Guidelines as Topic, Stroke, Risk Reduction Behavior
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